计算机化认知矫正治疗对精神分裂症患者脑白质弥散张量的影响

发布时间：2018-05-04 10:28

本文选题：精神分裂症 + 认知矫正　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的：精神分裂症(SZ)患者存在广泛的认知功能损害，神经影像学研究发现SZ患者脑白质纤维完整性受损，并且这种损害与认知损害有关；计算机化认知矫正治疗(CCRT)能有效改善患者的认知损害，但它改善认知功能的神经机制尚不清楚，特别是他对脑白质完整性的影响研究还较少。本研究采用磁共振弥散张量(DTI)技术尝试探讨CCRT的神经机制。方法：对15例符合美国精神疾病诊断与统计手册第4版（DSM-IV）SZ诊断标准、长期住院治疗的患者，及15名性别构成、年龄及受教育年限相匹配的对照组被试进行连线任务（TMT）、霍普金斯词汇学习任务（HVLT-R）、威斯康星卡片分类任务（WCST）测试、持续操作任务（CPT）以及数字广度测试（DS）等神经心理学背景测试，同时对SZ患者进行PANSS量表评定，然后所有被试进行DTI扫描。患者组进行为期6个月，每周3次的CCRT治疗后再次进行前述心理测验、PANSS量表及DTI扫描。观察患者组治疗前后认知功能、PANSS评分在CCRT治疗前后是否有差异；同时应用DTIstudio软件包对两组图像进行预处理，统计各个感兴趣区（ROIs）的FA值，观察治疗前后以及与正常对照组的差异。结果：1:患者组治疗前与正常对照组相比在TMT、HVLT—R、WCST、CPT以及DS任务上差异有统计学意义（P㩳0.01）；2：患者组治疗后与正常对照组相比在TMT、WCST、CPT、HVLT-R部分子任务以及DS的反序任务上有统计学差异（P㩳0.01或P㩳0.05），而HVLT-R延迟记忆、再认及DS的顺序任务上无明显差异（P㧐0.05）；3：患者组治疗前后相比在TMT、HVLT—R、WCST、CPT以及DS任务上均有显著提升，差异有统计学意义（P㩳0.01）；4：患者组治疗前后PANSS总评分及阴性分与治疗前有统计学差异（P㩳0.01或P㩳0.05），而阳性分无统计学差异；5：患者组ROIs与对照组比较FA降低的有双侧前扣带、双侧胼胝体压部、左侧小脑上脚（P㩳0.01或P㩳0.05），其他ROIs的FA值与对照组无统计学差异（P㧐0.05）；未发现患者组有脑区白质FA值高于对照。6、患者组脑白质FA值治疗前后无明显变化。结论：CCRT能有效改善SZ患者的认知功能损害，对精神症状作用不明显；SZ患者存在双侧前扣带、双侧胼胝体压部、左侧小脑上脚区域的白质纤维完整性异常，可能与SZ的认知损害有关，，CCRT对慢性病程的长期住院SZ患者白质纤维完整性影响不明显。
[Abstract]:Objective: there are extensive cognitive impairment in patients with schizophrenia (SZ). Neuroimaging studies have found that the integrity of white matter fibers is impaired in patients with SZ, and this damage is related to cognitive impairment. Computerized cognitive correction therapy (CCRT) can effectively improve the cognitive impairment of patients, but its neuromechanism for improving cognitive function is still unclear, especially his influence on white matter integrity. In this study, magnetic resonance diffusion Zhang Liang DTI technique was used to explore the neural mechanism of CCRT. Methods: fifteen patients who met the diagnostic criteria of DSM-IVSZ in the fourth edition of the American Handbook for the diagnosis and Statistics of Mental Disorders, and 15 patients with long-term hospitalization, and 15 patients with sex composition, were included in the study. Subjects matched in age and years of education underwent neuropsychological background tests such as TMTT, Hopkins vocabulary learning task HVLT-RN, Wisconsin card sorting task (WCST), continuous manipulation task (CPT) and digital span test (DSDS). At the same time, SZ patients were assessed with PANSS scale, and then all subjects were scanned with DTI. The patients were treated with CCRT 3 times a week for 6 months. To observe whether there were differences in cognitive function and PANSS scores before and after CCRT treatment in the patients group, and to use DTIstudio software package to preprocess the images of the two groups, and to calculate the FA values of each region of interest. The difference between before and after treatment and normal control group was observed. Results: there were significant differences in the tasks of TMTT HVLT-RnWCST-CPT and DS between the patients group and the normal control group before and after treatment. There were statistical differences between the patients group and the normal control group in the TMTWCST-CPT part of HVLT-R task and the reverse sequence task of DS after treatment. The difference was between P0. 01 and Pu. 05, while HVLT-R delayed memory. There was no significant difference in the sequence of recognition and DS tasks. There were significant differences in CPT and DS tasks between the two groups before and after treatment. There was significant difference in total PANSS score and negative score before and after treatment. There was no significant difference in positive score between patients group and control group. There were bilateral anterior cingulate band and bilateral corpus callosum in patients group compared with control group, but there was no significant difference in positive score between patients group and control group (P < 0.01), but there was no significant difference in positive score between patients group and control group (P < 0.05), there were bilateral anterior cingulate bands and bilateral corpus callosum in the patients group compared with the control group. The FA values of other ROIs in the left superior cerebellum were not significantly different from those in the control group (P < 0.05), and no significant changes were found in the white matter FA value of the patients group compared with the control group (P < 0.05), but there was no significant change in the white matter FA value before and after treatment in the patients group. ConclusionThe cognitive impairment of SZ patients can be effectively improved by WCCRT. There are bilateral anterior cingulate bands, bilateral corpus callosum and left superior cerebellar peduncles in patients with SZ who have no obvious effect on mental symptoms, and the white matter fiber integrity of the left superior cerebellum area is abnormal. CCRT may be related to the cognitive impairment of SZ. The effect of CCRT on the integrity of white matter fibers in long-term hospitalized SZ patients with chronic disease course is not obvious.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R749.3

【参考文献】